Tuesday, November 04, 2008

These Books, By Their Covers

"It is only when the mind and character slumber that the dress can be seen."

Ralph Waldo Emerson

Let me just say first that this post is in fact a reactionary one of a fellow blogger's - one about the hypocrisy of a health professional who indulges in the habit of smoking, and her abhorrence of the practice. I will address this (and by association, the issue of drinking as well), and broadly, on the human practice of giving values to things which are intrinsically worthless.

We humans are pattern-seeking creatures, constantly trying to make sense of this world and to decode the causality laws which govern our society - or as I often call it, the illusion of causality laws. And let's face it; we have been horrible at it. There was a time when we thought epileptics were recipients of divine possession (and we still do the same thing with the people who are essentially pretending to be epileptics i.e people who allegedly spoke in tongues).There was a time when mishaps and calamities in a close community was associated with the presence of a witch (which many villages in India still do, by the way). There was a time when we have tortured and put to death innocent women who were thought to be the witches perpetrating those mishaps and calamities through black magic. In the same way these days, though in a more low-key and politer fashion, we draw such erroneous conclusions from the behaviour and personal life of doctors; a class of people as mystical and unfathomable as epileptics and witches in the eye of modern society.

So, you may claim that a physician who smokes and drinks are in no moral position to advise a patient to stay away from the same vices. You can draw general arguments from idioms about leading from example or practicing what one preaches. All words, all philosophy. Not that I have anything against philosophy (which I have a pedestrian interest in by the way), but I'd prefer a more realistic approach to the question. And I will in turn deal with that with these questions of my own; what is a doctor, and how stupid are people, really?

A doctor is basically a fixer-upper you see whenever you are sick and needs fixing up. In the same way, you'd see a mechanic if your car's acting up and you'd call a plumber if your pipes are leaking. A doctor is service provider just like them. The big difference is, you respect and trust a doctor more than you trust the others because you are actually putting your life into his or her hand. Whether doctors, mechanics or plumbers smoke or drink, it does not in any way affect their ability to do their jobs (I'm not talking about drinking and being drunk at work here, of course - I'm merely referring to the habit). It was never in a doctor's job description to be the model of perfect health. Doctors are just human too like the rest of us. They can fall sick. They can get cancer. And they sure as heck can enjoy a good fag and nice cocktail if they want to in their free time after spending a whole day attending to your needs. Do you mistrust an oncologist who was diagnosed with cancer to effectively treat yours? Are the medications prescribed to you by a physician for your sore throat ineffective just because he or she had a sore throat before? Yes? No? No. Now tell me, why on earth a doctor who smokes or drinks can't advise you to quit the habits if it's in your best interest? Are you so stupid that you can't see a good advice when it's given, regardless of whether the person who gave it practices it or not? What if a murderer advices you not to commit murder?

Maybe, just maybe, people stupid enough to be confused by a good advice and a bad example should be allowed to do whatever they want to shorten their own lifespans. Their removal from the human gene pool cannot come fast enough, and will benefit our species in the long run.

I believe that the general public are not quite retarded enough to be misled into disregarding a medical advice just because the doctor who gave that advice does not adhere to it. It might be that the doctor in question aren't suffering from any underlying conditions which precludes his indulgence of cigarettes or alcohol. It might be because he just don't give a fuck. Patients are allowed the same freedom and autonomy over their own bodies - they can put whatever shit they feel like into themselves so long as they aren't breaking any laws. And just because a doctor doesn't smoke or drink is no guarantee that a patient will sheepfully follow suit. Likewise, when a patient has a mind to stick to his vices, he doesn't need a doctor who smokes and drinks - but who gave him the advice to quit them - to enable him. Substance addiction needs no excuses beyond itself.

"Well, so long he's not Cthulhu."

If I am undergoing a surgery of some sort, I might even prefer my surgeon to take a puff from a cigarette before he or she starts cutting into me. It's a widely-known medical fact that smoking increases a person's ability to concentrate. Heck, a doctor might even give better diagnoses after taking a drag from a fag, being able to focus better. If it can be conclusively and statistically proven that smoking doctors are better than non-smoking doctors, everyone will only want to be treated by doctors who smoke - role model and exemplary behaviour bullshit be damned.

Also, (I'm just speaking broadly here) a doctor who smokes and drinks would probably have better insight into the psyche of a patient who indulges in the same.

There are doctors and medical students sitting on their moral high horses who condemn other members of their fraternity for smoking and drinking, as though they are in some way better or that they have, through much difficulty, avoided or kicked the habits themselves. Balderdash. I'd wager that most, if not all of the people in this camp, have no personal inclination to smoke or drink to begin with. They are essentially denying other people what they themselves do not want. This is true hypocrisy. Being a doctor who smokes or drinks isn't.

I think that I have made my point pretty clear; the conjecture that a smoking, drinking doctor being a bad example to patients is utterly bogus. It's just something some people feel to be proper - much like how people feel that little girls should wear pink, chopsticks should be held on the right hand and Long Island Ice Tea should be served in a highball glass. That's right. It's simply a misplaced sense of propriety, and anyone deigning to impose a groundless practice of so-called medical etiquette grown from certain people's subjective opinion - mere feeling - about how doctors shouldn't smoke or drink onto others is a fascist. Don't be fascists, people. We medical students and doctors should practice more of that famous empathy we often boast so proudly about (not to mention that you'd be left feeling pret-ty stupid if a colleague of yours who smokes and drinks turns out to be a much better doctor than you'll ever be).

Before I conclude this, I just want to say that I personally abstain from smoking and think that no one should smoke either. And I seriously detest people who smokes in front of people who don't and gassing everyone with their second hand smoke - though I am too polite to point that out to some of my friends who did that. I do drink on occasion but never nearly enough to get intoxicated - I have a penchant for cocktails because I only drink for the taste, not for the high. I agree that doctors and medical students ought to know better than to smoke or overindulge in alcohol (the keyword here is "overindulge"; I researched a little bit into the health benefits of drinking moderately for a debate I participated in in a Community Medicine posting) but it's not our place to question their personal choices if those choices do not affect their ability to perform their duties. In fact, since doctors know best the myriad of diseases they are exposing themselves to by smoking or drinking, we should respect their decision to do so anyway, even if we cannot respect their judgment.

After all, they are making an informed decision, unlike everyone else.

P.S. And wearing a necktie won't make a doctor better at doing his job either. Like I said, we're too fond of giving values to things which are intrinsically worthless.

Knows what really matters,
k0k s3n w4i


phingy said...

but smoking is still bad for health o.O

Anonymous said...

d post remind me of house

- yuhhui - said...

Eh, great reply. You presented your case well, though you disagreed with me. Hehe.. But everyone's entitled to their own thoughts right? =) Nice post!!

Anonymous said...

See, that's why i like ur blog! u always put my ideas into your words!
By the way , i'm a doc who doesnt smoke or drink and works with lots of very good docs , academic ones, surgeons and physicians who do both!
Lets not make doctors into supergoody superhumans with no flaws.

MichelleG said...

my consultant surgeon was a smoker too, every time in between clinics he would go off for 15 mins for a puff. he's famous for that. lol but he does his job well..

and almost ALL doctors are caffeine-holic! my senior doctor told us that we'd be drinking coffee soon. they survive on coffee. we all need some vices in our live. =)

ap said...

this really helps me understand my brother the emaciated nicotine slave's claim to breaking my legs if i ever smoke. but more so that it is my decision to make. being able to concentrate sounds really attractive you know XD but i'm sure there are better alternatives

ap said...

btw i wonder what is your stand on marijuana

k0k s3n w4i said...

phingy: having not enough sleep is also bad for health. medical students and doctors are some of the biggest offenders. no one's denying how harmful smoking is - but I believe firmly in social liberalism. people should be allowed to choose.

anonymous1: house would have been a lot more succinct and wittier.

yuhhui: yes, everyone has a right and freedom to an opinion. sorry if I sounded a little vehement. Just couldn't pass up a good debate xD

anonymous2: it's beastly hard to speak one's mind accurately, isn't it? I actually started this blog to practice doing that. flaws are what make us humans - and there are flaws which do not reduce a doctor's standing, in my opinion :)

michelleg: he needs booster puffs xD luckily, I have not gotten myself stuck in the coffee ditch yet. Besides, coffee makes me twitch and my hands tremble. I'll stick to tea, thank you :D

ap: i think coffee's a pretty good alternative. i down cups of java during the exams - and I vouch for their efficacy. if only i'm not so sensitive to the damn stuff. I have a liberal opinion of marijuana. Considering its suitability in treating certain neurological illnesses, AIDS and some types of cancer - I'm surprise to find how prejudiced the world medical community is towards the herb (currently, only US recognizes its therapeutic properties - Netherlands, surprisingly, does not). With improved delivery techniques like vaporisation, the many adverse effects of smoking it are completely eliminated - though weed smokers is statistically shown to suffer no increased risk of lung malignancies (the THC or something else in cannabis has some protective role in that, apparently). More importantly, criminalising cannabis only forces people to go to dodgy dealers for their fix - and in the end, exposing more people to harder, more dangerous drugs pushed by these peddlers. We can't eliminate marijuana use - that's a fact - so why don't we regulate it? Strip it of its criminal elements and take it away from the shady side of the law. We can probably decrease the number of people leveling up to cocaine and heroin in the long run. Also, how many people die from marijuana use every year? ZERO. Cigarette smoking kills like half a million in 2000 in the United States. Alcohol claimed 85,000. Heck, even aspirin killed a decent 7,600! Legalise the damn weed already, I say. The fact that possession alone can earn you a death sentence in Malaysia is bloody ridiculous.

- yuhhui - said...

hey, no prob man. I was pretty vehement as well. Good debate topic eh. =p Maybe i should bring it up during PPD classes. heh. If the government legalise weed and other drug substances, won't it lead to further addiction and may cause more social problems? But then again, who knows, reverse psychology may work.. hmm...

k0k s3n w4i said...

yuhhui: you mistook me; i do not support the legalization of other drug substances. my support is solely for marijuana. and you're still thinking like you're writing a karangan for SPM - "won't it lead to further addiction and may cause more social problems?" :) for practical purposes, we need to see the facts here. people who are already addicted will remain addicted, regardless whether it's legal or not. people that won't try marijuana, won't start just because it's legalised (precisely the same reason why there are people whu don't smoke even though it's legal). people who want to try it will be able to get their hands on some anyway no matter how many laws you passed against it (if you've ever studied in a college or university in your life, you know precisely just what I meant). legalising marijuana can only be beneficial for the public, and I've given my reasons why in my previous comment. besides, do you know that marijuana is less addictive compared to nicotine? and that it's very nearly impossible to die from an overdose of the stuff? in fact, it's easier to die from drinking and smoking (and taking an over-the counter drug like aspirin). why don't we ban those then? and in countries which legalised marijuana (Netherlands for example), is there statistical proof that they have a higher percentage of drug-related crimes? you talk of social problems - what social problems are you talking about and where are your data to support your claims?

- yuhhui - said...

there're a lot of debates going on for this.. What you say holds water. But there are other hypothesis as well regarding this issue, about social problems, health problems etc.. not exactly a black white issue. IF i'm not mistaken,there's a book about how addiction of simpler drugs like this leads on to heavier drug usage and substances..but it's only a hypothesis. Hehe.. i dun wanna spark a debate here la. it's gonna go on.. hhahahah!! I think there was an article like that, that appeared in The Star before. heh

Terri said...

we had an argument about this is a philosophy tutorial once. we used the slippery slope argument against the legalising drugs issue. the thing is, if you legalise the "soft drugs" like cannabis and stuff, where do you draw the line? people will demand that you legalise slightly harder drugs as well. and then slightly harder. and on and and on until all sorts of dangerous substances are legal...

i do agree though, the fact that drugs are illegal don't really seem to be a deterrant. people go on and on about how education is the answer but that doesn't seem too effective either, does it? :/

and by the way, i think it is a fact that the crime rate in amsterdam is through the roof. i'm not too sure about statistic though. go look it up in your free time or something :P you could use it in your argument if i'm wrong *shrugs*

k0k s3n w4i said...

yuhhui: you're referring to the gateway drug hypothesis - basically something came up with people whu draw lines in the sand. it sounds reasonable, but again, we need a concrete correlation between marijuana usage and usage of harder drugs. Sure, people whu start abusing drugs often start with marijuana - but that's cos marijuana is the de facto "soft drug". Everyone, no matter which side of the law they are on, agree on this. The question is did people start using cocaine and heroin BECAUSE they used marijuana, or they merely took the druggie baby steps? I personally have very little confidence in the scientific articles posted by The Star. They supported several inconclusive researches as facts in the past - including that dumb "mint causes male impotence" one. And now I can't enjoy my favourite candies without people making stupid jokes about my sperm count. I have yet to read any respectable scientific papers supporting that theory yet.

terri: first, we already legalised soft drugs like alcohol and nicotine. the reason we don't see them in the light we see marijuana is because they are legalised, in spite of their conclusively proven health hazards. I notice that a lot of people tend to be too hung up about the general perception of things, neglecting the actual reality of the world (which is basically what this entire post is about). Secondly, about drawing the line, read some comparative pharmocological literature between marijuana and all the other hard psychoactive substances (cocaine, heroin, LSD etc) and you'll quickly have no problem seeing that the drugs aren't lined up equidistantly on some sort of metaphorical wheelchair ramp. marijuana is removed waaay below the rest. Marijuana use, if not legal in most parts of the world, is often tolerated in religious settings and in folk medicine - this stemmed from thousands of years of our species being accustomed to its properties. Even coffee suffered a similar debate by Muslim and Christian authorities back then. What people need to remember is that lines drawn by people in the past is not immutable and infallible. We know better than our ancestors nowadays - which is why I always take a realistic approach to things, taking thorough understanding of issues instead of bothering with drawing lines in the sand. As for the "crime rate in Amsterdam is through the roof" statement, here's a link; NETHERLANDS VERSUS USA
Funny thing is, lifetime prevalence of marijuana use is higher in the US (where it's illegal) compared to the Netherlands, where it is legal. Oh, and as it turns out, hard drug use is lower in the Netherlands as well. There goes all your lines in the sand. I believe if everyone in the world studies this issue historically, medically and sociologically in a thorough fashion, there wouldn't be a marijuana legalisation debate at all.

ap said...

i did some research on this issue myself when there was a debate on legalisation vs restriction. even though i lean far towards legalisation, as luck would have it i ended up on the restriction side, but i was fired up in a good way and gave a speech in a convincing tone anyway but got err sleepy reticence in return. this prevalence of apathy or ignorance, which really interrelates in the most profound way bothers me more than a little. i cannot even remember any substantial points on the restriction side..... that said, symbolism is very powerful indeed, even as it acts against reason it is endlessly pervasive, as you have admirably undertaken in this post. so begins the long and difficult task of displacing the social stigma...... unfortunately it is such an effective deterrant force as to exacerbate the demise of people fallen into the traps of addiction, as marginalisation seems to me a vice of society, punishing those who need help, that is ours to extend but would not be because of the suffocating stigma attached to somethings...... that is the hazy view i have of the things we label societal ills in general, quite incoherent i'm afraid

Anonymous said...

i am a year4 med student from melaka too. happy to see well versed blogs from melaka.

fully concur with your opinion on the topic mentioned. the crux of the matter is always everyone is entitled to their own thoughts like what yuhhui said and they make their own decisions. as long as it is an informed decision like what we will be asking our patients for their informed consent for any medical/surgical procedure, it is fine legally and morally, at least to me. =)

it is hard to break into conservative minds but it is a good start seeing that ppl are beginning to think for themselves rather than being feed foreign thoughts and ideas.

well written. =)